Based on clinical record review and interview with staff, it was determined that the facility did not maintain complete and accurate medical records related to fall investigation for one of eight records reviewed (Resident R6). Findings include: Review of facility reported incidents revealed that resident R6 sustained an unwitnessed fall on January 17, 2025. A request was made to employee E2, the Director of Nursing, at 1:30 p.m. on April 9, 2025, to provide the surveyors with the fall investigation report. On April 10, 2025, at 9:30 a.m. the facility provided the report. Employee E2 stated that they could not find the original report and that she had recapitulated it to a new form. Review of the form revealed that the document was dated as 4-9-25 for event 1-17-25. Interview with employee E2 on April 10, 2025, at 12:00 p.m. confirmed that because the facility was unable to locate the original document, the records for resident R6 were incomplete. 28 Pa. Code 211.12(c) Nursing service 28 Pa. Code 211.12(d)(1) Nursing service 28 Pa. Code 211.12(d)(2) Nursing service 28 Pa. Code 211.12 (d)(5) Nursing service

Based on review of facility policy, observations, and staff interview, it was determined that the facility failed to ensure foods were stored in accordance with professional standards for food service safety and that dishes were cleaned under sanitary conditions. Findings Include: Review of undated facility policy titled, Labeling and Dating, revealed the facility staff is to label and date all stored foods. Review of facility policy titled, Dishwashing Machine Operation- High Temperature, dated April 7, 2006, revealed staff is to check and record temperatures of wash and rinse water. Wash temperatures should reach 160 degrees Fahrenheit and rinse temperatures must reach at least 180 degrees Fahrenheit. Further review revealed staff is to record was and rinse temperatures on the dishwasher Temperature Log form and temperatures are checked throughout the dishwashing cycle. A tour of the Food Service Department conducted on July 25, 2023, at 10:27 a.m. with the Food Service Manager (FSM), Employee E4, and the facility Chief Executive Officer (CEO), Employee E5, revealed the following concerns: Observations in the dishwashing machine room area revealed clumps of dust all throughout the right side of the wall, exposing clean dishes to physical contamination. A blowing fan was observed moving the dust clump particles on the wall making dust particles unstable. Review of the dish machine temperature log revealed temperatures were not monitored throughout the month; the temperature log was blank. Interview with Employee E4 and E5 on July 25, 2023 at approximately 10:30 p.m. confirmed there was no dish machine temperature log monitoring for the months of April, May, June, and July of 2023. Observations in the walk-in freezer revealed the following foods were opened, undated, unlabeled, and without proper sealing to prevent freezer burn: french fries, waffle sweet potato fries, meatballs, chicken patties, breakfast waffles, and ravioli. Observations in the main kitchen area revealed very dirty stove top. Further observation revealed a layer of dust on the oven top and water leakage. Observations in the receiving/dumpster area revealed multiple clumps of plastic wrap, plastic sandwich bags, large clear trash bags, and leaves next to the green garbage can. Observations were confirmed by FSM, Employee E4, and CEO, Employee E5, along the duration of the tour. 28 Pa. Code 211.6 (f) Dietary Services